title: A case of rheumatoid arthritis improved from Steinbrocker classification class IV to class II after multi-joint surgery.
abstract: We report the case of a patient with rheumatoid arthritis (RA) who showed a reduction in disease severity (from class IV to class II) after multi-joint surgery. The patient was a 61-year-old man with a history of RA, type-2 diabetes, chronic obstructive pulmonary disease, and nephrotic syndrome. He had been undergoing treatment for RA for the past 10 years, but his condition could not be appropriately controlled. In addition to generalized edema, marked destruction of the left elbow joint and knees was observed, and he was unable to move in bed (Steinbrocker classification: stage IV, class IV). In March 2009, he developed suppurative arthritis of the left elbow (methicillin-sensitive Staphylococcus aureus [MSSA] infection) and was referred to our institution, where the infection subsided after cleaning of the wound and administration of antibiotics. In March 2010, he underwent artificial joint replacement arthroplasty of the left elbow, followed by replacement arthroplasty of the right knee in July that year and of the left knee in November. As of December 2011, the patient showed no signs of inflammatory reactions and was able to walk using crutches (Steinbrocker classification: stage IV, class II). Recent advancements in pharmacotherapy have made it possible to control the advancement of joint destruction in RA. However, in this patient, because of the advanced stage of joint destruction, surgical methods were required to aid the patient in recovering his ability to walk.
authors.affiliation: Department of Orthopedic Surgery, Kurume University Medical Center, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Matsuda
authors.forename: Masafumi
authors.initials: M
authors.lastname: Gotoh
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mitsui
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Yoshikawa
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Kume
authors.forename: Mayumi
authors.initials: M
authors.lastname: Yano
authors.forename: Seiyo
authors.initials: S
authors.lastname: Honda
authors.forename: Takahiro
authors.initials: T
authors.lastname: Okawa
authors.forename: Takaaki
authors.initials: T
authors.lastname: Fukuda
authors.forename: Fujio
authors.initials: F
authors.lastname: Higuchi
authors.forename: Kensei
authors.initials: K
authors.lastname: Nagata
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000145:classification* / Q000601:surgery* / Q000628:therapy*; D019643:Arthroplasty, Replacement; D048909:Diabetes Complications / Q000175:diagnosis; D004550:Elbow / Q000601:surgery; D005684:Gait; D006801:Humans; D007249:Inflammation; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000378:metabolism; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000150:complications; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012219:Rheumatology / Q000379:methods; D013203:Staphylococcal Infections / Q000150:complications / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents